To provide an overview of the pharmacological options for the treatment of
heroin- and
cocaine-dependent patients based on known biochemical pathways to addiction and the
chronic disease model as a starting point for treatment planning.
RESULTS: Recent pre-clinical and clinical studies indicate that different brain structures and different
neurotransmitters are involved in different stages of the addiction process. In addition, clinical experience shows that
heroin and
cocaine addiction can best be conceptualised and treated as a chronic, relapsing disorder with the following treatment goals: crisis intervention, cure or recovery (detoxification,
relapse prevention) and care or partial remission (stabilization and harm reduction). The various high-quality studies, systematic literature reviews and formal meta-analyses clearly demonstrate that today many proven effective interventions are available for crisis intervention, detoxification, stabilization and harm reduction for
heroin-dependent patients. Interventions directed at
relapse prevention are still problematic and only effective in a minority of motivated patients in stable living conditions and adequate social support. In contrast, no proven effective pharmacological interventions are available for the treatment of
cocaine-dependent patients, maybe with the exception of some patient groups that seem to benefit from treatment with
disulfiram or
amantadine. Treatment innovations are primarily based on experimental animal studies. Newly developed
cannabinoid receptor antagonists and
cortisol synthesis inhibitors show great promise.
CONCLUSION:
Heroin addiction is a chronic relapsing disease that is difficult to cure, but stabilization and harm reduction can greatly increase the life time expectancy and the quality of life of the patient, his direct environment and society as a whole. Currently, no proven effective pharmacological interventions are available for
cocaine addiction, and treatment has to rely on existing cognitive behaviour therapies combined with contingency management strategies.